| 1. |
- Becker, Mike O., et al.
(författare)
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Development and validation of a patient-reported outcome measure for systemic sclerosis : the EULAR Systemic Sclerosis Impact of Disease (ScleroID) questionnaire
- 2022
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 81:4, s. 507-515
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Patient-reported outcome measures (PROMs) are important for clinical practice and research. Given the high unmet need, our aim was to develop a comprehensive PROM for systemic sclerosis (SSc), jointly with patient experts. METHODS: This European Alliance of Associations for Rheumatology (EULAR)-endorsed project involved 11 European SSc centres. Relevant health dimensions were chosen and prioritised by patients. The resulting Systemic Sclerosis Impact of Disease (ScleroID) questionnaire was subsequently weighted and validated by Outcome Measures in Rheumatology criteria in an observational cohort study, cross-sectionally and longitudinally. As comparators, SSc-Health Assessment Questionnaire (HAQ), EuroQol Five Dimensional (EQ-5D), Short Form-36 (SF-36) were included. RESULTS: Initially, 17 health dimensions were selected and prioritised. The top 10 health dimensions were selected for the ScleroID questionnaire. Importantly, Raynaud's phenomenon, impaired hand function, pain and fatigue had the highest patient-reported disease impact. The validation cohort study included 472 patients with a baseline visit, from which 109 had a test-retest reliability visit and 113 had a follow-up visit (85% female, 38% diffuse SSc, mean age 58 years, mean disease duration 9 years). The total ScleroID score showed strong Pearson correlation coefficients with comparators (SSc-HAQ, 0.73; Patient's global assessment, Visual Analogue Scale 0.77; HAQ-Disability Index, 0.62; SF-36 physical score, -0.62; each p<0.001). The internal consistency was strong: Cronbach's alpha was 0.87, similar to SSc-HAQ (0.88) and higher than EQ-5D (0.77). The ScleroID had excellent reliability and good sensitivity to change, superior to all comparators (intraclass correlation coefficient 0.84; standardised response mean 0.57). CONCLUSIONS: We have developed and validated the EULAR ScleroID, which is a novel, brief, disease-specific, patient-derived, disease impact PROM, suitable for research and clinical use in SSc.
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| 2. |
- Holstensson, Maria, et al.
(författare)
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Comparison of acquisition protocols for ventilation/perfusion SPECT - a Monte Carlo study
- 2019
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Ingår i: Physics in Medicine and Biology. - : Institute of Physics (IOP). - 0031-9155 .- 1361-6560. ; 64:23
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Tidskriftsartikel (refereegranskat)abstract
- One of the most commonly used imaging techniques for diagnosing pulmonary embolism (PE) is ventilation/perfusion (V/P) scintigraphy. The aim of this study was to evaluate the performance of the currently used imaging protocols for V/P single photon emission computed tomography (V/P SPECT) at two nuclear medicine department sites and to investigate the effect of altering important protocol parameters. The Monte Carlo technique was used to simulate 4D digital phantoms with perfusion defects. Six imaging protocols were included in the study and a total of 72 digital patients were simulated. Six dually trained radiologists/nuclear medicine physicians reviewed the images and reported all perfusion mismatch findings. The radiologists also visually graded the image quality. No statistically significant differences in diagnostic performance were found between the studied protocols, but visual grading analysis pointed out one protocol as significantly superior to four of the other protocols. Considering the study results, we have decided to harmonize our clinical protocols for imaging patients with suspected PE. The administered Technegas and macro aggregated albumin activities have been altered, a low energy all purpose collimator is used instead of a low energy high resolution collimator and the acquisition times have been lowered.
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| 3. |
- Sandqvist, Patricia, et al.
(författare)
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Multiphase Iodine Contrast-Enhanced SPECT/CT Outperforms Nonenhanced SPECT/CT for Preoperative Localization of Small Parathyroid Adenomas
- 2019
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Ingår i: Clinical Nuclear Medicine. - 0363-9762 .- 1536-0229. ; 44:12, s. 929-935
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe aim of this study was to assess the value of intravenously contrast-enhanced CT in conjunction with 99mTc-MIBI SPECT for preoperative localization of parathyroid adenoma.MethodsOne hundred ninety-two patients with primary hyperparathyroidism were enrolled in the study between May 2015 and May 2017. The patients underwent a preoperative “one-stop shop” examination with 99mTc-MIBI SPECT/CT by using dual time-point (10 and 90 minutes) protocol and both nonenhanced CT and contrast-enhanced CT acquisition in the arterial and venous phase, 35 and 75 seconds, respectively, after contrast medium injection start. For 149 patients, the imaging results could be correlated to those at surgery and histopathology.ResultsThe median adenoma weight was 330 mg. The addition of contrast-enhanced CT increased the sensitivity from 81.1% to 89.9% (P = 0.003). The specificity of nonenhanced SPECT/CT was similar to contrast-enhanced CT (96.1% vs 97.9%; P = 0.077). For patients with uniglandular disease (n = 140, 94.0%), the sensitivity increased from 86.4% to 93.6% (P = 0.021) and the specificity from 96.2% to 97.9% (P = 0.118) by adding contrast-enhanced CT. In patients with multiglandular disease (n = 9, 6.0%), adding contrast-enhanced CT improved detection sensitivity from 42.1% to 63.2%. However, these patients were few and significance was not reached (P = 0.125).ConclusionsIn this cohort, with generally small parathyroid adenomas, the sensitivity in preoperative localization was greatly improved by adding contrast-enhanced CT to 99mTc-MIBI SPECT/CT.
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| 4. |
- Sandqvist, Patricia
(författare)
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Preoperative localisation of parathyroid adenoma in primary hyperparathyroidism using 99mTc-sestamibi SPECT/CT : an evolving scanning protocol
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Primary hyperparathyroidism (pHPT) is caused by one or more hyperfunctional parathyroid gland causing an inappropriately high release of parathyroid hormone (PTH) in relation to the calcium concentration in the blood. PTH acts on the bones to release more calcium and on the kidneys to reabsorb calcium, causing hypercalcemia. Approximately 75% of the patients are women and median age is 62. The only permanent cure is surgical removal of all pathologic parathyroid glands. To minimise the surgical exploration preoperative imaging localisation methods, have for decades been used and refined to pinpoint the culprit gland(s). The performance data for different imaging modalities used for preoperative localisation of hyperfunctional parathyroid glands are difficult to interpret. There are large numbers of studies on different methods with varying protocols and quality, often with insufficient reporting on important influencing factors such as adenoma weight and frequency of multiglandular disease (MGD). In this thesis we have analysed the performance of dual timepoint 99mTc-sestamibi SPECT/CT for preoperative localisation of PTAs with regards to its individual components: 99mTc-sestamibi SPECT alone [S], nonenhanced CT (native phase) [N], contrast-enhanced CT (arterial- and venous phase), [A] and [V] respectively and in combination [AN], [VN], [SN], [ANS], [VNS] and [SNAV]. Additionally, the impact of the adenoma weight and MGD on PTA localisation was also investigated. In Study I we retrospectively analysed 249 patients examined with nonenhanced 99mTcsestamibi SPECT/CT and found that adding a diagnostic native phase to 99mTc-sestamibi SPECT significantly increased the localisation specificity from 93.5% to 95.9% (p<0.01), but not the sensitivity. In a prospective examination of 192 patients (Study II) we reported that adding an arterial and venous phase to nonenhanced SPECT/CT [SN] significantly increased the localisation sensitivity from 81.1% to 89.9% (p<0.01) without changing the specificity. Using the same cohort, in Study III we showed that adding 99mTc-sestamibi SPECT to different combinations of CT phases increased sensitivity e.g., 80.8% for [AN] as compared to 86.5% for [ANS] (p<0.01). However, the use of both contrast-enhanced phases was found redundant in terms of sensitivity gain, just adding 4 extra mSv. The specificity was 97.9% for both. Although small parathyroid adenomas are known to be a challenge in preoperative localisation, we showed that it could be overcome using [ANS] or [SNAV]. The performance in patients with MGD remained unsatisfactory for all image sets, with a per-patient sensitivity of merely 30-40%. As a way of mitigating the consequences of this, in Study IV we trained a Machine Learning Classifier to recognise cases were preoperative localisation misclassified patients with MDG as single gland disease (SGD). As predictors, we used a set of pHPT related biochemical variables and the measured adenoma weight on patients cured after parathyroidectomy. On test data, the current classifier reached a 72% true positive prediction rate for MGD-patients and a misclassification rate of 6% for SGD-patients. These results call for further exploration before clinical implementation.
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| 5. |
- Sandqvist, Patricia, et al.
(författare)
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Primary hyperparathyroidism, a machine learning approach to identify multiglandular disease in patients with a single adenoma found at preoperative Sestamibi-SPECT/CT
- 2022
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Ingår i: European Journal of Endocrinology. - : Bioscientifica. - 0804-4643 .- 1479-683X. ; 187:2, s. 257-263
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Successful preoperative image localisation of all parathyroid adenomas (PTA) in patients with primary hyperparathyroidism (pHPT) and multiglandular disease (MGD) remains challenging. We investigate whether a machine learning classifier (MLC) could predict the presence of overlooked PTA at preoperative localisation with Tc-99m-Sestamibi-SPECT/CT in MGD patients.Design: This study is a retrospective study from a single tertiary referral hospital initially including 349 patients with biochemically confirmed pHPT and cured after surgical parathyroidectomy.Methods: A classification ensemble of decision trees with Bayesian hyperparameter optimisation and five-fold cross-validation was trained with six predictor variables: the preoperative plasma concentrations of parathyroid hormone, total calcium and thyroid-stimulating hormone, the serum concentration of ionised calcium, the 24-h urine calcium and the histopathological weight of the localised PTA at imaging. Two response classes were defined: patients with single-gland disease (SGD) correctly localised at imaging and MGD patients in whom only one PTA was localised on imaging. The data set was split into 70% for training and 30% for testing. The MLC was also tested on a subset of the original data based on CT image-derived PTA weights.Results: The MLC achieved an overall accuracy at validation of 90% with an area under the cross-validation receiver operating characteristic curve of 0.9. On test data, the MLC reached a 72% true-positive prediction rate for MGD patients and a misclassification rate of 6% for SGD patients. Similar results were obtained in the testing set with image-derived PTA weight.Conclusions: Artificial intelligence can aid in identifying patients with MGD for whom Tc-99m-Sestamibi-SPECT/CT failed to visualise all PTAs.
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| 6. |
- Sandqvist, Patricia, et al.
(författare)
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SPECT/CT's Advantage for Preoperative Localization of Small Parathyroid Adenomas in Primary Hyperparathyroidism
- 2017
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Ingår i: Clinical Nuclear Medicine. - 0363-9762 .- 1536-0229. ; 42:2, s. 109-114
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSES: The aims of this study were to assess the performance of Tc-sestamibi SPECT/CT, with diagnostic CT quality, compared with SPECT alone for preoperative localization of parathyroid adenomas and to assess the influence of adenoma weight on the correct adenoma lateralization with SPECT/CT and with SPECT alone.METHODS: Two hundred forty-nine consecutive patients, biochemically diagnosed with primary hyperparathyroidism, were examined with a combined SPECT/CT scanner. Subsequently, 200 patients with confirmed histopathology and biochemical cure after parathyroidectomy were included in this study (16 with multiglandular disease). For each patient, the SPECT-alone data were analyzed first. Thereafter, the CT information was added, and a new evaluation was performed with the combined data. In addition, for each patient, the diagnostic confidence with each method was graded on a scale based on the presence of different image features. The preoperative diagnostic findings were then compared with the surgical and histopathologic reports.RESULTS: The distribution of adenoma weights showed a peak at 210 mg, with a median at 338 mg. The sensitivity and specificity (multiglandular disease included) for correct classification of adenomas were significantly higher for SPECT/CT, 83% and 96%, respectively, than for SPECT alone, 80% and 93% (P < 0.01). Below 210 mg, the differences between SPECT/CT and SPECT alone in accurate adenoma lateralization were more prominent. Sixty-seven percent of all adenomas were graded with the highest confidence score with SPECT/CT compared with 53% with SPECT.CONCLUSIONS: SPECT/CT yields fewer false-positive findings than SPECT alone. The advantage of SPECT/CT over SPECT alone was most apparent for correct lateralization of small adenomas (<210 mg).
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| 7. |
- Sandqvist, Patricia, et al.
(författare)
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The preoperative localisation of small parathyroid adenomas improves when adding Tc-99m-Sestamibi SPECT to multiphase contrast-enhanced CT
- 2021
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Ingår i: Insights into Imaging. - : Springer Science and Business Media LLC. - 1869-4101. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo investigate the incremental value of Sestamibi SPECT combined with a non-enhanced and contrast-enhanced CT, using SPECT/CT, for the preoperative localisation of small parathyroid adenomas (PTA).MethodsRetrospectively, 147 patients surgically cured from primary hyperparathyroidism, as verified by biochemistry 6 months postoperatively, were included. All patients had preoperatively undergone a dual time 99mTechnetium-Sestamibi SPECT (S) with multiphase CT including native (N), arterial (A) and venous (V) phases. Independently, two radiologists blinded from both the surgical and the preoperative imaging reports, sequentially performed PTA localisation starting with either [A] or [V], thereafter [A + N] or [V + N] and finally with the complete [A + N + S] or [V + N + S]. PTA localisation was reported for each image-set. The readers results were combined and the diagnostic performance for each image set was determined. Sensitivity was also calculated for the different quartiles of PTA weight distribution.ResultsThe median adenoma weight was 315 mg. No statistically significant differences in diagnostic performance between arterial and venous based image sets were found. The net effect of adding [N] was to increase specificity. Sestamibi SPECT significantly increased the overall diagnostic accuracy for arterial- and venous-based image sets, p = 0.0008 and p = 0.001, respectively. [A + N + S] was found to have the highest diagnostic performance with 86.5% sensitivity and 94.9% overall accuracy. [A + N + S] was particularly advantageous for locating PTA in the lower weight quartiles.ConclusionsNative CT-phase and dual time point Sestamibi SPECT increase specificity and sensitivity, respectively. These, in combination with a single contrast-enhanced CT-phase is the most optimal examination protocol for preoperative localisation of PTA using SPECT/CT.
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